PROJECT ABSTRACT The growing population of persons with dementia presents challenges to providing high quality nursing home (NH) care. Care is complicated by behavioral and psychosocial symptoms of dementia (BPSD) such as aggression, vocal outbursts, wandering, and withdrawal that occur as persons with dementia lose cognitive and communication abilities and cannot verbally express unmet physical and psychosocial needs. NH staff use ?elderspeak,? speech similar to baby talk that is demeaning to residents. Residents react to elderspeak with BPSD resulting in increased use of psychotropic medication to control BPSD, higher staffing needs, more staff stress and turnover, and increased costs. The Changing Talk (CHAT) training program educates staff about elderspeak and better communication strategies and is proven to reduce staff elderspeak and BPSD in NH residents. To increase dissemination, this effective classroom-based training has been transformed to online internet modules that improve access for busy staff including those in rural and small NHs and increase ease of dissemination across long term care service settings. To further enhance training effects, SPEEKO for Elderspeak, an automated performance-based app that uses natural language processing has been developed to provide immediate reinforcement of training to staff at the point-of care. This study will build on app proof of concept to establish feasibility of use in the clinical setting and will test preliminary efficacy of the app for augmenting the effect of training on reducing elderspeak communication in dementia care. This R21 will conduct a clinical trial in response to PAR-18-179; Research on Informal and Formal Caregiving for Alzheimer?s Disease by testing a technology-based, natural language processing app to support caregivers in addressing unique challenges of providing advanced dementia care. We will demonstrate feasibility of use at the point-of-care with five certified nursing assistants, and further validate the app?s accuracy by comparing app outputs reporting diminutive use to results from transcription and psycholinguistic coding. Hypothesized app effects on augmenting reductions in staff elderspeak diminutive use after training will be tested in a cluster randomized trial comparing immediate and delayed feedback with 60 CNAs in 6 nursing homes. If effective in boosting training effects, this readily scalable app can be disseminated across long term care service and support settings to increase communication training effects that will reduce resident BPSD and psychotropic medication use and provide periodic reinforcement for communication training. The goal is to further improve and sustain effects of communication training in nursing staff that will reduce BPSD and inappropriate use of psychoactive medications. This nonpharmacological approach uses available technology to improve dementia care and aligns with the top priority goal of the National Partnership to Improve Dementia Care. As the number of persons diagnosed with dementia triples in the next 30 years, empowering care providers to provide high quality care for individuals with dementia is of critical importance.